Are you tired of working nights, holidays, and weekends thus looking to leave bedside nursing? Are you ready to use your nursing experience to make an impact in people’s lives? Do you value high quality care? Come join our growing team and enjoy the home-work life balance that is not easily obtained by nurses. This position may be fully remote or located at one of our offices in Appleton (WI), Madison (WI), Phoenix (AZ), Austin (TX).   The Telehealth RN Case Manager will be a key contributor to the success of our Clinical Engagement Center focused on improving member’s health and wellness...

The Quality Control Analyst (QCA) is responsible for supporting and coordinating quality control analysis and related processes for activities performed by Navitus Health Solutions. The QCA I is responsible for engaging in preventive and detective quality controls that can be measured quantitatively and qualitatively to validate Navitus processes. The QCA I will work with oversight and moderate independence to ensure quality control validations are completed in a timely manner. This individual requires an intermediate understanding of quality controls and how to apply such controls to department processes.   The QCA I shall have the ability to learn critical department processes with operational relevance...

Due to growth, we are adding a Paralegal to our Legal and Regulatory Affairs department!     The Paralegal will support Navitus, Lumicera, and their subsidiaries by (a)...

Due to growth, we are adding a Sr. Developer, Business Intelligence to our FFS Solutions Resources department. 

Under direction from the Assoc. Manager, Patient Support Services and pharmacists in the Specialty Pharmacy, the Intake Specialist I is primarily responsible for enrolling new Specialty Pharmacy patients and ensuring that all pertinent patient information is contained within the record. Patient information shall include demographics, allergies, medication history, comorbidities, and payer information. The Intake Specialist I’s main objective is to place phone calls to new and existing patients, answer phone calls and contact the doctors and patients via fax or phone or other communication means. The Intake Specialist I is also responsible for accurately translating prescription information and all other...

The Privacy Manager will assist Compliance team and company in meeting the privacy expectations of the compliance program, including controls, policies & procedures, communications, and training. The Privacy Manager will work in a professional role with a high level of independence, to ensure reported privacy incidents are investigated, program elements are implemented, and controls are examined periodically for effectiveness and efficiency. The Privacy Manager will lead department analysts and serve in a back-up role to Compliance leadership team. The role requires knowledge of privacy regulations including HIPAA and state data breach and privacy laws; interoperability, records management and access processes, investigative processes; policy management;...

Navitus Health Solutions is seeking a Medicare Services Executive to join our Government Programs department! 

Job Summary: The Reimbursement Analyst, Pharmacy Network is responsible for the operation of the Navitus Maximum Allowable Cost (MAC) pricing program and other generic and brand reimbursement systems with pharmacy providers.  The objective is to achieve market leading discounts, fair reimbursement to providers, and to ensure maximum competitive pricing is attained. The Analyst supports and evaluates agreements with providers and the MAC program through financial price modeling, analysis, and reporting. This position will communicate and work cross functionally with other teams on generic trends and generic drug discount change effects. Provider and...

The Operations Manager, Medicare Part D serves as a subject matter expert in Medicare Part D EGWP product operations. This individual will plan, coordinate, and align resources to support the daily activities of the team. This position will interact with Navitus clients and internally with leadership and key subject matter experts across the organization. The Operations Manager fosters a great place to work by clearly communicating mission, goals, and expectations for team members, while recognizing individual and team achievements. In addition, the Operations Manager resolves escalated issues arising from operations and coordination with other departments. This role requires excellent verbal and written communication skills,...

LumiceraHealth Services is seekinga Patient Care Assistant to join ourPatient Services

The Senior Analyst, Network Contracting will be responsible for the financial management of retail, specialty, and mail order pharmacy contracting, issue management, and reporting, in support of the network strategy to deliver value to Navitus clients.  The primary responsibilities of this role are to analyze current and new pharmacy contracts and provide support for all phases of the pharmacy contracting process, including national and regional chain providers, pharmacy services administration organizations (PSAOs) and independent pharmacies for all lines of business.    The Network Contracting Senior Analyst will analyze contract alternatives to support Network...

Navitus Health Solutions is seeking a Sr. Client Services Executive I to join our TX Campus/Contract Performance Management department! 

Navitus Health Solutions is seeking an Associate Manager, Implementation to join our Implementation department! 

Navitus Health Solutions is seeking a Sr. Proposal Analyst to join our Proposals department!   The Sr. Analyst I, Proposal supports and/or leads the client acquisition and retention efforts of Navitus...

Due to growth, we are adding Systems and Quality Analyst Manager to our team.    The Systems and Quality Analyst Manager will provide support for the development, implementation, and maintenance of our FFS Medicaid products.   The FFS...

The Sr. Business Analyst provides business analysis support to the development, implementation, and maintenance of all products within the Fee For Service(FFS) Department. The Sr. Business Analyst will interact with key operating departments related to Fee For Service (FFS) Department business development and operational compliance. The Sr. Business Analyst also understands the roles and responsibilities of the business area and how it fits within the entire corporation. This individual develops an understanding of Government Programs regulations and related CMS and/or specific state guidance and is responsible for proactive review of all...

Due to growth, we are adding this Contracting and Audit Specialist to our Trade Relations department.   The Contracting and Audit Specialist will assist with the business needs of the payer relations and contracting team which may include supporting proactive contracting compliance to prepare for and/or mitigate future audits, and respond to requested audits, prescription validations, and audit responses such appeals and requests for additional information. The primary responsibility of this position is to effectively manage all payer program compliance and responding...

Due to growth, we are adding a Client Services Specialty Coordinator to our Strategic Partnerships team.   The Client Services Coordinator (CSC) is a highly motivated professional with at least 5 years of successful experience interfacing directly with varied complex customers preferably in healthcare, to manage existing clients and strategic partners. The position is responsible for the co-development of long-term account strategy and supporting the National Specialty Account Executive for their assigned client.   Working with other operational staff to provide the client and their patients an exceptional service and high...

This is a hybrid role working 2-3 days onsite each week at our Madison campus located at 361 Integrity Dr, Madison, WI 53717.   Due to growth, we are adding a Analyst, Revenue Cycle Management to our Accounting team.   The Analyst, Revenue Cycle Management is responsible for supporting the Sr. Manager, Revenue Cycle Management in implementation and ongoing administration of best-in-class billing and accounts receivable systems and processes.  The...

Navitus Health Solutions is seeking a Client Services Executive to join our Account Management team!   The Client Services Executive (CSE) is a highly motivated professional with at least 5 years of successful experience interfacing directly with varied complex clients preferably in healthcare, to manage existing Pharmacy Benefit Management clients. The position is responsible for the co-development of long-term account strategy for their assigned clients. Working with subject matter experts, the CSE will be for responsible for identifying “up sell” and expansion opportunities and communicating these opportunities appropriately to be incorporated into the...

What can you expect from Navitus? - Hybrid Madison WI  - Paid Volunteer Hours - Educational Assistance Plan and Professional Membership assistance - Referral Bonus Program – up to $750! - Top of the industry benefits for Health, Dental, and Vision insurance, Flexible Spending Account, Paid Time Off, Eight paid holidays, 401K, Short-term and Long-term disability, College Savings Plan, Paid Parental Leave, Adoption Assistance Program, and Employee Assistance Program

Navitus Health Solutions is seeking a Sr. Software Developer to join our IT Development department! 

Navitus Health Solutions is seeking a Project Manager, Implementation TPA/Employer to join our Implementation department! The Project Manager, Implementation TPA/Employer (IPMT) is a highly motivated professional with at least 3 years of successful project management experience interfacing with TPA and/or employer type clients to manage projects that could include but is not limited to transitioning clients to Navitus from their current PBM, implementing new services/programs, and facilitating a change in vendor relations. The position is responsible for building an early relationship with...